Preoperative Endovascular Embolization of Glomus Tumors; A Safe and Efficacious Adjuvant Treatment

Yıl 2019, , 417 - 422, 31.12.2019

Hasanali Durmaz , Bülent Öcal Erdem Birgi , Onur Ergun Kemal Keseroğlu , Emel Çadallı Tatar Baki Hekimoğlu , Mehmet Hakan Korkmaz

https://doi.org/10.24938/kutfd.602951

Öz

Objective: The aim was to evaluate the outcomes
of preoperative endovascular embolization for glomus tumors including glomus
caroticum, glomus jugulare, and glomus vagale.

Material and Methods: Between 2012 and 2017, eighteen
patients with glomus tumors were diagnosed by angiography and some of them were
embolized. Data were extracted for demographics, tumor subtype and size,
embolization, and the rate of complication. The efficacy of tumor embolization
was determined by comparing angiography before and after the intervention.
Patients were followed-up for at least 24-48 hours for vital signs and possible
complications.

Results: A total of 18 patients underwent
diagnostic angiography and of these, tumor was embolized in 10 patients. Six
patients had glomus jugulare, 1 had glomus vagale, 10 had glomus caroticum and
1 had concurrent glomus caroticum and vagale. The most common embolized artery
was ascending pharyngeal artery with a rate of 50%. Post-embolization
angiography revealed that blood flow to tumor had decreased at least by 70%. No
complications related to the procedure were experienced in any of the patients.

Conclusion: Endovascular selective artery embolization
prior to surgery is a safe and effective method in treatment of glomus tumors.

Anahtar Kelimeler

Endovascular procedures, glomus, embolization

GLOMUS TÜMÖRLERİNİN PREOPERATİF ENDOVASKÜLER EMBOLİZASYONU; GÜVENİLİR VE ETKİN BİR ADJUVANT TEDAVİ SEÇENEĞİ

Öz

Amaç: Glomus
karotikum, vagale ve jugulare tümörlerinde preoperatif yapılan endovasküler
embolizasyon işlem sonuçlarının değerlendirilmesi amaçlandı.

Gereç
ve Yöntemler: 2012-2017 yılları arasında glomus tümörü nedeniyle 18
hastaya tanısal anjiyografi ve bazılarına da embolizasyon yapıldı. Hastaların
demografik bilgileri, tümör tipleri, embolizasyon ve komplikasyon oranları
analiz edildi. Tümör embolizasyonunun etkinliğine, girişim öncesi ve sonrası
alınan anjiyografiler karşılaştırarak karar verildi. Hastalar girişim sonrası
vital bulgular ve olası komplikasyonlar açısından en az 24-48 saat takip
edildi.

Bulgular: Tanısal
anjiyografi yapılan 18 hastadan 10’una eş zamanlı embolizasyon da uygulandı.
Altı hastada glomus jugulare, 1 hastada glomus vagale, 10 hastada glomus
karotikum ve 1 hastada eş zamanlı glomus jugulare ve vagale mevcuttu. En sık
embolize edilen arter %50 oranı ile asendan faringeal arterdi. Embolizasyon
yapılan hastalarda tümör kan akımında en az %70 oranında bir azalma meydana
geldiği saptandı. Yapılan işlemler ile ilgili herhangi bir komplikasyon
oluşmadı.

Sonuç: Endovasküler selektif arter embolizasyonu glomus
tümörlerinin preoperatif tedavisinde güvenilir ve etkin bir yöntemdir.

Anahtar Kelimeler

Endovasküler prosedürler, glomus, embolizasyon

Kaynakça

• 1. Baysal BE. Hereditary paraganglioma targets diverse paraganglia. J Med Genet. 2002;39(9):617-22.
• 2. Martin TP, Irving RM, Maher ER. The genetics of paragangliomas: a review. Clin Otolaryngol. 2007;32(1):7-11.
• 3. Boedeker CC, Ridder GJ, Schipper J. Paragangliomas of the head and neck: diagnosis and treatment. Fam Cancer. 2005;4(1):55-9.
• 4. Fliedner SM, Lehnert H, Pacak K. Metastatic paraganglioma. Semin Oncol. 2010;37(6):627-37.
• 5. Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO et al. Paragangliomas of the head and neck. Oral Oncol. 2004;40(6):563-75.
• 6. Murphy TP, Brackmann DE. Effects of preoperative embolization on glomus jugulare tumors. Laryngoscope. 1989;99(12):1244-7.
• 7. Kocur D, Ślusarczyk W, Przybyłko N, Hofman M, Jamróz T, Suszyński K et al. Endovascular Approach to Glomus Jugulare Tumors. Pol J Radiol. 2017;82:322-6.
• 8. Chen PG, Nguyen JH, Payne SC, Sheehan JP, Hashisaki GT. Treatment of glomus jugulare tumors with gamma knife radiosurgery. Laryngoscope. 2010;120(9):1856-62.
• 9. van den Berg R. Imaging and management of head and neck paragangliomas. Eur Radiol. 2005;15(7):1310-8.
• 10. Myssiorek D. Head and neck paragangliomas: an overview. Otolaryngol Clin North Am. 2001;34(5):829-36.
• 11. Valavanis A. Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions. AJNR Am J Neuroradiol. 1986;7(5):943-52.
• 12. Tikkakoski T, Luotonen J, Leinonen S, Siniluoto T, Heikkila O, Paivansalo M et al. Preoperative embolization in the management of neck paragangliomas. Laryngoscope. 1997;107(6):821-6.
• 13. Smith RF, Shetty PC, Reddy DJ. Surgical treatment of carotid paragangliomas presenting unusual technical difficulties. The value of preoperative embolization. J Vasc Surg. 1988;7(5):631-7.
• 14. Luna-Ortiz K, Rascon-Ortiz M, Villavicencio-Valencia V, Granados-Garcia M, Herrera-Gomez A. Carotid body tumors: review of a 20-year experience. Oral Oncol. 2005;41(1):56-61.
• 15. Davidson J, Gullane P. Glomus vagale tumors. Otolaryngol Head Neck Surg. 1988;99(1):66-70.
• 16. Jackson CG. Glomus tympanicum and glomus jugulare tumors. Otolaryngol Clin North Am. 2001;34(5):941-70.
• 17. Larouere MJ, Zappia JJ, Wilner HI, Graham MD, Lundy LB. Selective embolization of glomus jugulare tumours. Skull Base Surg. 1994;4(1):21-5.
• 18. White JB, Link MJ, Cloft HJ. Endovascular embolization of paragangliomas: A safe adjuvant to treatment. J Vasc Interv Neurol. 2008;1(2):37-41.
• 19. Persky MS, Setton A, Niimi Y, Hartman J, Frank D, Berenstein A. Combined endovascular and surgical treatment of head and neck paragangliomas-a team approach. Head Neck. 2002;24(5):423-31.
• 20. Tasar M, Yetiser S. Glomus tumors: therapeutic role of selective embolization. J Craniofac Surg. 2004;15(3):497-505.